Alcohol dependence syndrome (pdf)

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Alcohol Dependence Syndrome

Niharika Thakkar

Child Guidance Centre and Department of Behavioural Sciences and Mental Health, Sahyadri Hospitals ltd, Pune

Phases of Alcoholism – Jellinek (1960)

PRE-ALCOHOLIC PHASE

CHRONIC PHASE•Benders•Tremors•Protecting the Supply•Unreasonable Resentments•Nameless Fears and Anxieties•Collapse of the Alibi System•Surrender Process

CRUCIAL PHASE•Loss of Control•The Alibi System•Eye-Openers•Changing the Pattern•Anti-Social Behavior•Loss of Friends, Family or Job•Seeking Medical Aid

PRODROMAL PHASE•Gross Drinking Behavior•Blackouts•Gulping and Sneaking Drinks•Chronic Hangovers

Types of Alcoholism – Jellinek (1960)

Alpha alcoholism Beta alcoholism Gamma alcoholism Delta alcoholism Epsilon alcoholism-Dipsomaniac

Stages of Change- Prochaska and DiClemente (1984)

PrecontemplationNot currently considering change:

"Ignorance is bliss" Techniques:Validate lack of readiness Clarify: decision is theirs Encourage re-evaluation of current behavior Encourage self-exploration, not action Explain and personalize the risk

ContemplationAmbivalent about change:" Sitting on the fence" Not considering change within the next month

[Miller and Rollnick (1991)] Techniques Validate lack of readiness Clarify: decision is theirs Encourage evaluation of pros and cons of

behavior change Identify and promote new, positive outcome

expectations

PreparationSome experience with change and are

trying to change: "Testing the waters" Planning to act within 1monthTechniques: Identify and assist in problem solving Help patient identify social support Verify that patient has underlying

skills for behavior change Encourage small initial steps

ActionPracticing new behavior for 3-6 monthsTechniques: Focus on restructuring cues and social

support Bolster self-efficacy for dealing with

obstacles Combat feelings of loss and reiterate

long-term benefits

MaintenanceContinued commitment to sustaining new

behavior Post-6 months to 5 yearsTechniques: Plan for follow-up support Reinforce internal rewards Discuss coping with relapse

RelapseResumption of old behaviors:

"Fall from grace" Techniques: Evaluate trigger for relapse Reassess motivation and

barriers Plan stronger coping

strategies

Motivational Interviewing

Denial Individual is encouraged to reach own

decision about change Therapists’ role facilitate the changeAim Cognitive DissonanceGoal Self actualization

Behaviour Interventions

Cue Exposure: Compulsion will be reduced if the urge is restricted

Aversive Condition : Chemical or shock

Covert Sensitization: Imagined + taught-Least aversive-Number of trials decided by therapist-Self control (most commonly used, effective)-Flexible-Inexpensive-Tailor cut

Cautions: - Urge has to be targeted- Prevent “inappropriate

generalization”- Side effect: anger, resentment,

aggression- Lack of co operation

Procedure: Close eyes Imagine : Target response to be weakened Imagine an aversive stimulus Clarity of image Indicate degree of aversiveness Practice till clarity of image reported 20 scenes- 10 described by therapist, 10 imagined out of

description Taped: listen to tape twice a day In-vivo practice Combine with cover reinforcement: Imagine a pleasant scene

Behaviour Therapy in Substance Use

Therapeutic relationship I-P skills Good outcome (Yalom, Lieberman, Mac Donough,

Empathy

Cohesiveness Congruence

Poorer Outcomes: Confrontational styles of therapist

Motivational Enhancement : Miller and Rollnick (2002)

Relapse Prevention

Marlatt &Gordon (1985) -Social Learning-Behavioural rehearsal-Assertiveness training-Lapse-relapse “Emergency

plan”How to Say no.mp4

Psychosocial

Alcoholics Anonymous group (12 step approach)

Functional Analysis

Maintaining factors Triggers and precursors Consequences Problem areas :

Relationship, work, legal, medical, interpersonal, financial : Particular “cognitions”

Implementing goals of treatment

Generic treatment plan : Denial- Educate- Facilitate into program like AA

Goal: Total abstinence Sobeil & Sobeil (1976): ‘Controvercial’ Model Goal: Moderated drinking

Behavioural Self control training

Education oriented: Therapist directed; Self directedRationale: Abstinence: Patient refuse; high ADS Choice of goals 1.) Self efficacy 2.) Self control 3.) 6-12 sessions (90mins) + Booster sessionsSteps: Limit setting Self monitoring Rate of drinking Social skills training Contingency managementAlcohol Ads affect.mp4

Qualitative Inventory of Alcohol Disorders

Chalo, Bye